Barriers to Complete Immunization in North-Central Nigeria: The Role of Banditry and Insecurity – A Commentary

Abstract

Despite decades of investment in childhood immunisation, Nigeria retains the second-largest population of zero-dose children globally, with an estimated 2.3 million children remaining unvaccinated as of 2022. In North-central Nigeria, escalating banditry, kidnapping, and farmer-herder violence have emerged as critical but under-examined structural determinants of immunisation inequity. This commentary examines the multi-level barriers to complete childhood immunisation in this context, drawing on literature published between 2021 and 2025 and applying a socioecological framework. Analysis reveals that insecurity disrupts health system functioning through facility closures, workforce displacement, and cold-chain failures, while simultaneously restricting caregiver access due to fear of violence, population displacement affecting over 2.1 million persons since 2019, and economic hardship. Community trust deficits, amplified by misinformation and sociocultural hesitancy, particularly pronounced in northern states where full immunisation coverage falls below 40%, further impede vaccine uptake. Data gaps in conflict-affected zones obscure the true scale of coverage loss. The commentary calls for security-sensitive, community-centred, and geospatially informed immunisation strategies to reverse these trends and protect the most vulnerable children in North-central Nigeria.